The current best drug treatment for hypertensive heart failure with preserved ejection fraction.

Autor: Rist A; Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Sevre K; Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Wachtell K; Weill-Cornell Medicine, Division of Cardiology, New York City, NY, USA., Devereux RB; Weill-Cornell Medicine, Division of Cardiology, New York City, NY, USA., Aurigemma GP; Division of Cardiovascular Medicine, Department of Medicine, UMass Chan School of Medicine, Worcester, MA, USA., Smiseth OA; Institute for Surgical Research and Department of Cardiology, University of Oslo, Rikshospitalet, Oslo, Norway., Kjeldsen SE; Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Ullevaal Hospital, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: s.e.kjeldsen@medisin.uio.no., Julius S; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA., Pitt B; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA., Burnier M; Centre Hospitalier Universitaire Vaudois, Service of Nephrology and Hypertension, Lausanne, Switzerland., Kreutz R; Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany., Oparil S; Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA., Mancia G; University of Milan-Bicocca, Milan, Italy., Zannad F; Inserm, Centre d'Investigations Cliniques-1433 and F-CRIN INI CRCT, Universite de Lorraine, Nancy, France.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2024 Feb; Vol. 120, pp. 3-10. Date of Electronic Publication: 2023 Oct 19.
DOI: 10.1016/j.ejim.2023.10.008
Abstrakt: More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.
Competing Interests: Declaration of Competing Interest SEK reports lecture honoraria from Getz, Emcure, JB Pharma, Merck KGaA, Vector-Intas, and Zydus. BP is receiving consulting fees from and owning stock options in Relypsa/Vifor, KBP Pharmaceuticals, Sarfez, SCPharmaceuticals, SQinnovations, G3 Pharmaceuticals, and Tricida, receiving consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim/Lilly, and PhaseBio, and holding patent US 9,931,412 on site-specific delivery of eplerenone to the myocardium and pending patent US 63/045,784 on histone-acetylation modulating agents for the treatment and prevention of organ damage. MB reports honoraria from Bayer, Menarini, Sanofi, and Servier. RK reports support for research by Bayer, and honoraria for lectures from Bayer, Berlin-Chemie, Daiichi Sankyo, Ferrer, Merck, Menarini, Sanofi, and Servier. GM reports honoraria from Astra Zeneca, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Menarini, Merck, Novartis, Recordati, Sandoz, Sanofi, and Servier. FZ reports personal fees from Boehringer Ingelheim, Janssen, Novartis, Boston Scientific, Amgen, CVRx, AstraZeneca, Vifor Fresenius, Cardior, Cereno Pharmaceutical, Applied Therapeutics, Merck, Bayer, and Cellprothera, other than from CVCT, and Cardiorenal. AR, KS, KW, RBD, GPA, OAS, SJ, and SO declare no competing interests.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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